Tyler, Joan (2)

'CAMA /❑ DREDGE & FILL N A B rc D
ENERAL PERMIT Previous permit #
New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources E
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4i" `
Rules ttached.
Applicant Name :� - 1 'i, ; Project Location: County
Address Street Address/ State Road/ Lot #(s)
City , ' '� t i i� ' ,` State 9 ZIP
Phone # Subdivision
Authorized Agent ��
Affected ❑Cw *•• -1,PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes /i no I PNA yes /
Type of Project/ Activity
Pier (dock) length--'
Fixed Platform(s)
Floating Platform(s)'""""""" -
Finger pier(s)
r
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore ----
Basin, channel - -
cubic yards
Boat ramp
Boathous Boatlift %
Beach
Other
Shoreline Length 1 ! �­
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
❑ ES ❑ PTS
❑ UBA ❑ N/A
A building permit may be required by: 1 '
( Note Local Planning Jurisdicti",
Notes/ Special Conditions `
City t
Phone #
Ad'. Wtr. Bod'
Closest Maj. Wtr. Body
ZIP �'J� 14
River Basing
e I
nat r•
(Scale:
t ❑ See note on bacl r ga ding River Basin rules.
I-'" Gxi f )11
� i I
Agent or Appl/'cant Printed Name ^, Permit Officer's Pnnted Name
Signature lease read compliance statement on back of permit" Signature ""-y----
Apphcation,Fee(s) c `Check' Issuing Date Expiration Date ,

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
0 Tar - Pamlico River Basin Buffer Rules 0 Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement.net/
Revised 08/27/14

Y�-

0
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date &r Z� — ?01cS
Name of Property Owner Applying for Permit:
A)
Mailing Address:
%©5' j AR eC D/-t
® r 0,
I certify that I have authorized (agent) i U19NY wt-�S/VAI to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) /� ®� �/� ?� . !'_ /-naR' 4,320
This certification is valid thru (date) C2 ` /tc
Bois
Owner Sig ture Date
RECEIVED
SEP 16 2015
RECEIVED
SEP 14 2015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to TyZ E/2 's
(Name of Property Owner)
property located at 70 S f 9
_ (Address, Lot, Block, Road, etc.)
on �� LL7 �? � I6 K , ind f"AD C T/ , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio . "
I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
L/
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must beset
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the. appropriate blank below.) RECEIVED
I do4tsh to waive the 15' setback requirement. SEP 14 2015
_ I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
A
Signatu e ,.
Print or a Name
J Aft
Mailin Address
�F l05 Ppr�IL ar
City/State/Zip
Telephone Number
o9- 11- 201.5
Date
Signature
Print or Type Name
RECEIVED
D� 2 P v �' A's SEP t 61015
Main Address
z :2� C)�
City/State/Zip
Telephone Number.
9�
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY; OWNER STATEMENT
I hereby certify that. I own property adjacen'tto .Ton of TX1
(Nome of Property Owner)
property locatad 2t 4 764
(Address, Lot, Block,.Roa.d, efc-)—
on
FFLI- E 76
inN.C.
(Waterbody) (City/Town an or CoUnty)
The. applicant has described to me, as shown below, the development proposed at the above
location
I have no objection to this proposal.
I have objection's to this proposal.
DESCRIPTION AND/OR I) R*AW14G.OF PROPOSED DEVELOPMENT
findkidual proposing development must fill in' desc'ripfibn below or attach a. site drawing)
0 K -W 0,
�,
7
WAIVER SECTION
I. understand that a pier, dock, rnooring:pl boathouse, lift or groin must be set
back a minimum distance of 15' from my area OT riparian accessunless waived by Me. (if you
rh
wish to waive the setback,. you must initial appropriate blank below.) YECEIVIFn-
2015
I L do wish to wane the 15" setback requirement.
"D �71r-
I do not wish` b waive the 15' setback requirement.
(Prqpr Owner Information) (Adjacent Property Owner Information)
Si e
Signature
J0 A if T A 15
W,Ar-TAW
4705- FJqRK 'Dr.
C4Y 'Istate"ZiP
Aike ,&1191D CITY'Ne as h
Tel.6pho.he Number
o9 - I Y- - An 1�r,
Ddie
Jlm� L-Is'k- 0
Date U
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(Waterbody) . —(City/Town yfTown and/or Cdunty)
The applicant has described tome, as shown below, the development proposed at the above
loca_
_._ I have no objection to this proposal.
1. have objections to this proposal.
DESCRIPTION AN®l0R DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deveiopment must fill in description below or attach a'site drawing)
V TP%1 r L.4 % %a`y 4 i.vw
I . understand that a pier, dock, mooring pilings, breakuuater, ,boathouse, lift; or groin must be set
back a minimum distance of 15' from my area of nparian.access .unless waived by me. (if you
wish to waive the setback, you must initia6 the appropriate blank below.)
do wish to waive "the 15" setback requirement.
I do not wish`to waive the 15' setback requirement. .
(Property Owner Information) (Adjacent Pr party Owner Information)
i
S gytat e S. tw
RECEIVED
Print or Type Na Print pr Typ Name g� 1
` t SEP 16 2015
Mailm Address � Mailin�d�s 4.4 �� S7
Cit /State/Zi i
Y p ��,�`% CitylSfate2ipa(�
Tele hone Number Telephone Nu bar
p� p r RECEIVED
Date Date SEP 0 8 2015
ham! s --
��� (Revised 6/18/2012) -
,_
ar ,�,� c•J�e�n �br�- - -�. L,4,j `p